Individual provider Active NPI

Kristina Velinova, MHC, LPC, CASAC

  • Mental Health Counselor
  • Staten Island, NY
National Provider Identifier
1053508804
Registry record updated Aug 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
002775-1 Issued in NY
Practice address
576 Ilyssa Way
Staten Island, NY 10312-6602
Phone
(347) 282-9221
NPI assigned
Sep 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 17506 NY
Professional Counselor 101YP2500X 37PC00342900 NJ
Mental Health Counselor 101YM0800X 002775-1 NY Primary

Addresses

Primary practice location

576 Ilyssa Way
Staten Island, NY 10312-6602

Mailing address

576 Ilyssa Way
Staten Island, NY 10312-6602
Phone (347) 282-9221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240201000449 NY Practitioner - Mental Health Counselor 0143673566 Practice locations: Staten Island, NY

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2691 Hylan Blvd
Staten Island, NY 10306-4357
Phone (347) 282-9221

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17506NYMDAddiction (Substance Use Disorder) Counselor
002775-1NYMDMental Health Counselor
37PC00342900NJMDProfessional Counselor

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1053508804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 ILYSSA WAY",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103126602",
            "telephone_number": "347-282-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 ILYSSA WAY",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103126602",
            "telephone_number": "347-282-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELINOVA",
        "first_name": "KRISTINA",
        "credential": "MHC, LPC, CASAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-25",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "17506",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00342900",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "002775-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.